Dr. Eisner Answers Your IBD Questions
I have been taking Humira 40 mg every other week for Crohn's disease. I notice that after a week or so, I start having worsening symptoms. Is it possible to take the Humira more frequently?
Humira is a self-injected biologic that has been very effective in patients with Crohn's disease. It is in the same drug class as Remicade, as opposed to a two-hour infusion in either the hospital, ambulatory care center or physician's office, patients self-inject themselves similar to the manner in which Insulin or Interferon is given. Currently, Humira is approved at 40 mg every other week for patients with moderate to severe Crohn's disease. Studies have been done to assess the efficacy of weekly dosing. While some patients have an improvement in symptoms when treated with 40 mg of Humira a week, there were no statistically significant differences as compared to bi-weekly dosing. The problem that exists is similar to the problem that exists when considering Humira in the treatment of patients with Ulcerative Colitis: getting the insurance company to cover the cost of the drug. Check with your doctor to see if he can either suggest an alternative treatment or if he can work with your insurance company to see if they might consider approving the more frequent dosing regimen.
How do I avoid getting a colitis attack during the holiday season?
Many conditions can induce a colitis flare. Stress, lack of sleep and dietary discretion, all common during the holiday season, can lead to an increase in symptoms of colitis. As usual, it is very important to be compliant with your medication. Secondly, avoid foods that tend to lead to diarrhea including milk and other dairy products, foods rich in cream or gravies and high fiber foods, especially if you are prone to loose stools. Alcohol sometimes can lead to increased colitis symptoms, and can interact with some colitis medications as well. While it is important to have fun during the holiday season, be sure to pay attention to the health of your gastrointestinal tract.
I have been on Asacol for Ulcerative Colitis for many years. Most often I take two pills three times a day, occasionally going as high as four pills four times a day. I have a hard time remembering to take my pills, especially during the holiday season. Any ideas?
Mesalamine, the active ingredient in Asacol, is also found in a new product, Lialda. As opposed to the 400 mg Asacol pill, Lialda comes in a 1200 mg pill, which has a delayed release, so that it is only taking once a day. Since you take six Asacol, or 2400 mg a day, you should do just as well with two 1200 mg Lialda tablets in the morning. In addition to increased efficacy rates due to compliance, patients taking Lialda were shown to have high rates of colonic mucosal healing. You should check with your doctor to see if your condition (and your drug plan) are appropriate for Lialda.
I recently underwent a right colon resection for colon cancer. Since the surgery, I have experienced significant watery diarrhea. I have tried Imodium without relief. Any ideas?
The right colon is responsible for the absorption of water and bile acids. When the right colon is removed, it might be difficult for the remainder of the colon to compensate for its loss, and watery diarrhea develops. Agents that bind bile acids, such as Questran or Welchol are excellent in correcting this problem. Another possibility is a toxin-mediated diarrhea due to antibiotics. Antibiotics are commonly given at the time of surgery, and can lead to an overgrowth of intestinal bacteria, one of which produces a toxin causing a watery diarrhea. This can easily be treated with an antibiotic after diagnosis is made by checking a stool culture. You should check with your doctor to have these possibilities investigated.