1. I am being treated for Crohn's disease, and lately, I have been experiencing tingling sensations in my fingers and toes. I am seeing a neurologist shortly, but is there any correlation between my Crohn's disease and my neurologic symptoms?
Earlier this year, researchers looked at over 150 patients with Crohn's disease and Ulcerative colitis. They found that they were about four times more likely to develop neuromuscular conditions, including carpal tunnel syndrome and small fiber neuropathy, which causes pain and lack of feeling in the feet. Those with bowel disease were also more than six times more likely to also have a disorder called sensorimotor polyneuropathy, a nerve disease that can cause weakness, pain, and numbness. These diseases were more common in women with bowel disease than men. There are two likely explanations for this. In Crohn's disease, the end of the small intestine (distal terminal ileum) is typically involved with inflammation. This is the part of the gastrointestinal tract that is responsible for absorbing vitamin B12. Your neurologic symptoms are common in patients with B12 deficiency, and you might benefit from monthly injections of B12 if that is the case.
The other common cause would be related to medications that might be used to treat inflammatory bowel disease. Flagyl, an antibiotic commonly used, is known to cause numbness and tingling in the extremities as a result of a peripheral neuropathy. Additionally, many patients with inflammatory bowel disease take steroids such as Prednisone. Steroids can cause elevations in glucose medication induced diabetes) that can also increase the risk of peripheral neuropathy.
In any event, whether you take these medications or not, you should see your gastroenterologist for a blood test that should include a B12 level and glucose, and if no explanation is found, a consultation with a neurologist would be recommended as well.
2. I am a 45 year old female with Crohn's disease. Is my risk of osteoporosis increased?
Inflammatory bowel disease is associated with a decrease in bone density and the development of osteoporosis. Factors that contribute to a low bone density in patients with inflammatory bowel disease include malnutrition, low body mass, poor food quantity intake, history of smoking and genetic factors. Since you suffer from inflammatory bowel disease it is important to be aware of your long term risks for low bone density. You should speak with your doctor about regular bone density screenings, increasing calcium and vitamin D intake and increasing exercise and strength training.
3. I have been having abdominal pain and diarrhea for the past few months. My doctor thought that I might have inflammatory bowel disease, but a colonoscopy and small bowel X-ray were normal. As my symptoms have persisted, my doctor now wants to do a small bowel capsule endoscopy. What is that?
Small bowel capsule endoscopy is essentially a pill with a camera in it, or a Pillcam. When swallowed, the capsule transmits images at the rate of approximately 2 pictures per second, to a receiver worn by the patient. After eight hours, the receiver is returned and the capsule passes in to the colon where it is eliminated in stool. The receiver is then downloaded to a computer where the images can be viewed. The images of the distal small bowel are much more sensitive at diagnosing Crohn's disease than a small bowel X-ray. With this relatively new diagnostic tool, many cases of previously undiagnosed Crohn's disease can be discovered.