Question:
I have had Crohn's Disease for five years and I want to get pregnant. I am feeling well and I want to stop my medications so I can have a drug-free pregnancy, and nurse my child after delivery. Is this approach okay?

Dr. Kane:
While every women would love to have a “drug free” pregnancy, the goal here is to have a healthy, safe pregnancy. It is terrific that your disease has been in remission so long, and a testimony to the importance of maintenance medications. There are actually studies that show that people who have been well for 5 years and then taken off their medications are more likely to experience a flare than those patients who continue on their medications. A sick mom is the worst scenario for a pregnancy, and stopping your medications puts you at risk for getting sick. The detriment to the baby of a sick mother is far greater than any risk of medications. Our obstetrical colleagues would agree that treating Crohn's to keep it in check is just as important during pregnancy than any other time.

Question:
I have had ulcerative colitis involving all my colon for just over 20 years. I was very sick years ago but now I have no symptoms. My doctors said I should have a yearly colonoscopy. Why is this necessary if I feel perfectly well?

Dr. Kane:
When a patient has ulcerative colitis involving their entire colon, the risk for colon cancer increases after 10 years of the disease. This risk does not go away just because you feel well. It is very important to undergo regular surveillance colonoscopies so that your doctor can try to identify polyps or small growths before they turn into bigger growths, ie cancer. Patients with disease over 20 years are recommended to undergo yearly colonoscopy regardless of how old they are or how well they feel.

Question:
I have a lot of diarrhea and my doctor says I have an irritable colon but my friend says she has Crohn's with the same symptoms, how can you tell which disease you have, and can you have both?

Dr. Kane:
Diarrhea and cramps can be an indication of lots of different ailments of the gastrointestinal tract. Only with careful history taking, a full physical exam and appropriate tests like a colonoscopy with biopsies and/or xrays and possibly blood tests to look for malnutrition or anemia can you tell if there is inflammation or just irritability causing the symptoms. It is possible also for a patient to have both Crohn’s disease and irritable colon at the same time. A consultation with a gastroenterologist can help discern what is going on in your digestive system.

Question:
I have ulcerative colitis for 2-3 years and have been continually ill. I have been taking prednisone and a 5ASA drug. Are there other medicines available to get me better? If I don't get better will I have to have surgery and wear a bag?

Dr. Kane:
There has been some exciting new developments in the treatment of ulcerative colitis ie the FDA approval of infliximab (Remicade‚) for the treatment of moderate to severe ulcerative colitis. Other possible treatments include azathioprine/6-mercaptopurine or possibly cyclosporine. If you are not well and continue to require steroids, you should discuss with your physician alternate medical therapies. If surgery becomes the most logical choice, then most patients can be treated with removal of the colon with an internal pouch built from small intestine that connects to the anus and thus allows for regular stooling behavior. Wearing a bag after colitis surgery has become a thing of the past for most patients with the advancements of surgical techniques. If surgery is recommended, it is wise to seek the opinion of an experience surgeon who has performed many of these types of operations.

Question:
If there a specific diet that has been proven to work for ulcerative colitis?

Dr. Kane:
Alas, there is no magic diet that “works” for ulcerative colitis. Everybody’s body chemistry is just a little bit different, and thus there is no one diet that applies to everyone. What we do know is that certain foods are not processed by the human body like celery, mushrooms and corn. Eating these can cause cramps, bloating and diarrhea but do not necessarily make the colitis worse. Avoiding dairy is only helpful for those who are truly lactose intolerant. Avoiding wheat and wheat gluten has been touted as a “cure” but ulcerative colitis is not like celiac disease and will not make the colitis go away. Working with a nutritionist and your physician to tailor a diet that will not be life altering and feasible is the best way to keep your colitis and sanity in check.

Question:
I have been reading a great deal about something called "probiotics" for Crohn's Disease. Can you explain it's role in treating IBD?

Dr. Kane:
“Probiotics” are otherwise known as “good bacteria”. The human intestines harbor millions of bacteria of various species that help us digest our food and keep us healthy. When there has been inflammation, the chance of disruption of the normal population of bacteria is higher. Replenishing the bacteria can help with restoration of normal function. The best source of probiotics is yogurt, as probiotics have to be alive when taken or else they are ineffective. The most common probiotics include acidophilus, lactobacillus, and bifidobacterium. These are available at most drug and nutrition/health stores but their freshness is not guaranteed as is yogurt. There are preparations available over the internet, the most popular being VSL#3 that is a combination of different strains. Their role in the treatment of Crohn’s disease is to help restore normal balance of bacteria that can be lost with the use of antibiotics and the chronic inflammation. They are considered “adjunctive” therapy which means they are in combination with other regular therapies.