Dr. Eisner Answers Your IBD Questions

Todd Eisner Health Guide
  • I have been experiencing a lot of lower abdominal pain and crampy diarrhea. I have had a colonoscopy and endoscopy as well as a capsule endoscopy. My physician thinks I might have microscopic colitis. I don't understand what that is. Will I get better?


    Microscopic colitis is the term given to colitis when the colon looks normal to the eye, but inflammatory cells are seen under the microscope. There are basically two types of microscopic colitis: Collagenous colitis and Lymphocytic colitis. In collagenous colitis, the normal layer on collagen in the colon is thickened. In lymphocytic colitis, there is an increased amount of lymphocytes in the colon wall. Both processes cause a watery diarrhea. Treatment is the same, initially anti-inflammatories specific to the colon such as Asacol, and if that fails, treatment with steroids such as Entocort or Prednisone. Most patients respond and do well, and then the medication can be tapered. Some patients will require long-term therapy. You should check with your doctor to see what the best treatment for you is.

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    A few months ago, I had terrible diarrhea and cramps and was diagnosed with a gastroenteritis. While I am generally better now, I still have very mild symptoms. My stools are not as formed as they used to be, and are a little more frequent. What can this be?


    There are a few things that come to mind. First off, it is possible that your problem a few months ago was not gastroenteritis, but rather the start of a more chronic process such as ulcerative colitis or Crohn's disease. Secondly, a percentage of patients who suffer from gastroenteritis go on to have a post-infectious irritable bowel syndrome that can last a long time. Thirdly, especially if you were treated with antibiotics, but even if you weren't, you may have either an overgrowth of intestinal bacteria, or possibly even a toxin mediated diarrhea such as pseudomembranous colitis.


    There are a few things that your doctor can do to distinguish amongst them. First, stool should be checked for infectious processes as well as white blood cells. If there are white blood cells present then the possibilities remain ulcerative colitis/Crohn's or pseudomembranous colitis. If there are no stool white cells present, then this is likely either bacterial overgrowth or irritable bowel syndrome. Depending on the severity of your symptoms, then either prophylactic treatment with antibiotics such as Flagyl or Xifaxan, or a flexible sigmoidoscopy or colonoscopy can be performed to make the diagnosis. You should check with your physician to see what the best option for you is.



    I have ulcerative colitis and am on Asacol. While my disease is under control, at times I need to take my Asacol three times a day, sometimes three to four pills at a time. Are there any alternatives?


    While Asacol is an excellent treatment for colitis, at times, when patients flare, the reason is because they are not compliant with the drug. Recently, Lialda was developed, which is essentially a longer acting, larger concentration of Asacol. Both are mesalamine products. One Lialda tablet is equivalent to three Asacol tablets. Additionally, since Lialda is long acting, it is only taken once in the morning. Therefore, if patients are taking six, nine or twelve Asacol tablets throughout the day, they can take two, three or four Lialda in the morning respectively. Results have shown that patients do much better, as there is better compliance. Currently, the manufacturer of Asacol is in the process of developing an 800 mg Asacol tablet that will similarly increase patient compliance. You should check with your doctor to see if you are a candidate for Lialda.


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    I had a colonoscopy a few years ago and had some polyps removed. When should I have my next one?


    While there are many factors involved when deciding when the next colonoscopy should be performed when someone has polyps, in general, if small polyps are found, the recommendation would be to repeat the examination in three to five years. If multiple or large polyps are found, then the recommendation would be to repeat the examination at one to three years. Factors such as history of colitis, family history of colon cancer and a previous poor colonoscopy prep will also play a role in determining when the next examination should be. You should contact your gastroenterologist and find out when you should schedule your next colonoscopy.


Published On: November 12, 2008